title: Pharmacogenetic workup of perioperative serotonin syndrome.
abstract: Serotonin syndrome is gaining attention in perioperative and chronic pain settings due to the growing prevalence of multimodal therapies that increase serotonin levels and thereby heighten patient risk. A patient's genetic make-up may further increase the risk of serotonin syndrome. A case of serotonin syndrome on emergence after general anesthesia is presented. A subsequent cytochrome P4502D6 genetic test result suggested a potential alteration in metabolism. For this patient, who was taking combination antidepressant medications and receiving common perioperative medicines, additive pharmacodynamic effects converged with a pharmacogenetic predisposition, resulting in serotonin syndrome.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. Electronic address: beatty.nicole@mayo.edu.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Beatty
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Nicholson
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Loralie J
authors.initials: LJ
authors.lastname: Langman
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Curry
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Eisenach
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D004347:Drug Interactions; D000068736:Duloxetine Hydrochloride; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000235:genetics*; D020230:Serotonin Syndrome / Q000175:diagnosis / Q000209:etiology / Q000235:genetics*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects; D013876:Thiophenes / Q000009:adverse effects
chemical_list: D019389:Cytochrome P-450 CYP2D6; D000068736:Duloxetine Hydrochloride; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes
keywords: Duloxetine; Multimodal therapy; P4502D6 chromosome; Perioperative serotonin syndrome; Pharmacogenetics